Combined pill

The hormones in the combined pill prevent pregnancy. There are different types of the combined pill.

Combined pill: an overview

There are different types of combined pill, which use different brand names.

The most common are 21 day pills, where you take one pill every day for 21 days, then stop for seven days (to follow your 28 day menstrual cycle), although there are other regimes.

Another option is to take 'every day' pills. In this case, you will take one pill every day with no break, but seven of these are 'dummy' pills which do not contain any hormone.

You should follow the instructions in your packet, as each type is taken differently.

The hormones in the combined pill prevent pregnancy by:

  • Thickening the mucus in the neck of the womb, so it is harder for sperm to penetrate the womb and reach an egg
  • Thinning the lining of the womb, so there is less chance of a fertilised egg implanting into the womb
  • In some women, the combined pill also stops the ovaries from releasing an egg (ovulation), but most women will continue to ovulate.

You can book an appointment for contraception at axess here.

Lasts for
Bleed pattern
Can control bleeds

*for perfect use (typical use 91%)

Frequently Asked Questions

How do I take my pill?

There are different types of pills and many different brands. You should follow the instructions in your packet, as each type is taken differently.

When taking the combined pill, you may plan to have a withdrawal bleed once a month. A withdrawal bleed is not the same as your period. It is caused by you not taking hormones during a pill-free break or on placebo pill days.

Most instructions tell you to take a seven-day pill-free break, but you can choose to shorten this break, or to miss it and not have a withdrawal bleed.

Missing, or shortening the break, could help you if you get heavy or painful bleeding, headaches, or mood swings on pill-free days. When you miss taking a pill just before, or just after, a pill-free break, you're most at risk of pregnancy. Taking a shorter break or missing the break might make it less of a risk that you'll get pregnant.

Are there any side effects from taking the combined pill?

Although serious side effects are not common, there are some risks associated with the combined pill.

The common, short term side effects include:

  • Temporary side effects such as headaches, nausea, breast tenderness, mood swings. These often improve over time but can be persistent
  • Some bleeding and spotting in the first few months.

The common, long term side effects include:

  • Some loss of libido
  • Changes to your skin.

Rare side effects include:

  • There is a small increased risk of some serious health conditions, such as thrombosis (blood clots in legs or lungs), although this risk is higher in pregnancy than being on a combined pill
  • There is also a small increase in the risk of breast cancer or cervical cancer. These risks reduce with time after stopping the pill.
  • It may cause hair loss and chloasma (dark patches over your face)

You should discuss any concerns you have with your clinician or GP.

Will the pill affect my future fertility?

When you stop using the combined pill, your fertility will return to how it was before.

Do not worry if your periods don't start immediately. For some women, it can take a few months.

Will the combined pill affect my periods?

The combined pill prevents ovulation and limits the build-up of the lining of the womb (endometrium) that is usually lost with your period.

This may result in a shorter, lighter, and often less painful bleed. It is not a period, as the pill stops your natural cycle.

Your bleeding pattern depends on the pill taking regime you choose.

Can I take my next pack of pills straight away to miss a bleed?

It is not harmful to continue to take your next pack of pills without a seven day break, or miss out inactive (dummy) pills with EveryDay combined pills.

The Faculty of Sexual and Reproductive Healthcare has issued guidance regarding taking the combined pill without a monthly seven day break:

  • 'Tricycling' is taking a pill each day without any breaks for three continuous packs (nine weeks). Then stop for seven days - during this time you may or may not bleed. Continue taking the pill in this manner (three packs continuously followed by seven days off).
  • 'Extended pill taking' is taking a pill each day without any breaks, until you notice three to four days of continuous bleeding (where you need to use a tampon or pad). Stop taking the pill for the next three to four days, even if the bleeding stops. Then resume taking the pill every day, and when one pack is finished go straight on to the next pack. Don’t worry if you don't bleed, it doesn’t occur with everyone. When starting this method, you must take a pill for 21 consecutive days before taking a break.

(It is noted that these ways of taking the pill are ‘off licence’ use. This does not mean it is unsafe, but that taking the pill in this way is not within the UK product license.)

How will the pill affect my bleeds?

Bleeding is common when you first start taking the combined pill. It can take up to three months to settle down, but it’s very important to keep taking the pills to the end of the pack, even if your bleeding is heavier than usual.

Once your body is used to the pill, your bleeds should become regular, with bleeding during the pill-free week.

Bleeding can also be caused by not taking the pill correctly, or by a sexually transmitted infection or pregnancy. If the bleeding does not settle down or if you are concerned, speak to your GP, sexual health clinic or call NHS 111 for advice. For sexual health testing, visit your nearest axess clinic or order a test.

What should I do if I vomit or have diarrhoea while taking the pill?

If you vomit within two hours of taking the combined pill, it may not have been fully absorbed into your bloodstream. Take another pill straight away and the next pill at your usual time.

If you continue to be sick, keep using another form of contraception while you're ill and for seven days after recovering.

Very severe diarrhoea (six to eight watery stools in 24 hours) may also mean that the pill doesn't work properly. Keep taking your pill as normal, but use additional contraception, such as condoms, while you have diarrhoea and for seven days after recovering.

Speak to your healthcare professional, or call NHS 111 for more information, or if your sickness or diarrhoea continues.

Does the combined pill cause cancer?

Research is ongoing into the link between breast cancer and the pill. Research suggests that users of all types of hormonal contraception have a slightly higher chance of being diagnosed with breast cancer compared with women who do not use them. However, ten years after you stop taking the pill, your risk of breast cancer goes back to normal.

Research has also suggested a link between the pill and the risk of developing cervical cancer and a rare form of liver cancer. However, the pill does offer some protection against developing endometrium (lining of the womb) cancer, ovarian cancer and colon cancer.

The combined pill may reduce the risk of fibroids, ovarian cysts and non-cancerous breast disease.

Does the combined pill cause weight gain?

Research has not shown that the combined pill leads to weight gain. Some women find that their weight changes due to fluid retention or an increase in appetite, but this should settle over time.

What happens if I miss a pill?

If you have missed one pill, anywhere in the pack:

  • Take the last pill you missed now, and take the next pill at the normal time
  • Continue taking the rest of the pack as usual
  • You don’t need to use additional contraception, such as condoms
  • Take your seven day pill-free break as normal.

If you have missed two or more pills (you are taking your pill more than 48 hours late) anywhere in the pack:

  • You may need emergency contraception: use the Lowdown's pill calculator to see whether you require this
  • If you do require emergency contraception, you can use our website to find out how you can access this.

If you are not sure what to do, continue to take your pill, use another method of contraception, such as condoms, and seek advice from your local sexual health clinic, pharmacy, or GP, as soon as possible.

Are there any possible longer-term side effects of taking the pill?

Taking the combined pill can increase your blood pressure. This is why it is important to have your blood pressure monitored yearly.

There is a small increased risk of some serious health conditions, such as thrombosis (blood clots) and breast cancer or cervical cancer.

These risks reduce with time after stopping the pill.

Can any other medication change the effectiveness of the combined pill?

Some medicines make the combined pill less effective (including those used to treat epilepsy, HIV and tuberculosis, and the herbal medicine St John’s Wort).

Ask your healthcare professional or pharmacist and read the information that comes with your medicine.

Can the combined pill affect my mood, or make me feel depressed?

There are lots of combined pills with different types and levels of hormones.

If the pill is affecting your mood, there may be another pill that is more suitable for you.

If you find your mood is worse during the week that you are not taking your pill, consider using a different pill taking regime with no, or fewer, breaks.

Is the combined pill suitable for me?

Most people can take the combined pill, but your healthcare professional will ask about your family and medical history to determine whether or not it is the best method for you.

The combined pill may not be suitable for those who:

  • Are a smoker (or stopped smoking less than a year ago) and are 35 or older
  • Are very overweight.

It may also be unsuitable if you currently have, or have previously had, certain health conditions. This will be discussed with you by your clinician.

How quickly does the combined pill start protecting me against pregnancy?

This depends on when in your cycle you start taking it, or if you have been taking any other hormonal contraception.

If you start within the first five days of your menstrual cycle then it will be effective immediately.

If you start after the first five days of your cycle then the combined pill will not be effective for 7 days.

If you are switching from one method of contraception to another then you should talk to your doctor or nurse about using additional contraception.

Why do the pill packets look different?

You may sometimes be provided or prescribed a different brand of pills, but your healthcare professional will explain that the hormones and doses will be the same.

I don't like the thought of taking medication for a long time. Will there be any long-term effects on my health if I take the combined pill for several years?

Some reports suggest that there may be a very small increased risk of breast cancer and cervical cancer, but the pill does help protect against other types of cancers such as ovarian, colon and uterine cancers.

There is no evidence to suggest the pill causes infertility. Most women, who have regular periods will find that their normal cycle will return within six months. Some women find that their usual cycles begin again very quickly after stopping, but for others it can take longer.

The benefits of long-term use of the pill usually outweigh the risks.

Are there any health risks to be aware of when taking the pill?

See a doctor straightaway if you have any of the following:

  • Pain in the chest, including any sharp pain which is worse when you breathe in
  • Breathlessness
  • You cough up blood
  • Painful swelling in your leg(s)
  • Weakness, numbness, or bad 'pins and needles' in an arm or leg
  • Severe stomach pains
  • A bad fainting attack or you collapse
  • Unusual headaches or migraines that are worse than usual
  • Sudden problems with your speech or eyesight
  • Jaundice (yellowing skin or yellowing eyes).
How does the combined pill affect the menopause?

The combined pill may reduce menopausal symptoms in some women, but is not recommended for women over 50.

Can I take the combined pill after having a baby?

If you have just had a baby and are not breastfeeding, you can start the pill on day 21 after the birth. You will be protected against pregnancy straight away. If you start the pill later than 21 days after giving birth, you will need additional contraception (such as condoms) for the next seven days.

If you are breastfeeding, you should wait until six weeks after childbirth before starting a combined pill (this also applies to a patch or ring). There is little research about the effects of these methods on breastfeeding, however some studies of starting the combined pill earlier have found no effects on either breastfeeding or on baby’s growth, health and development.

Can I take the combined pill after a miscarriage or abortion?

If you have had a miscarriage or abortion, you can start the pill up to five days after this and you will be protected from pregnancy straight away.

If you start the pill more than five days after the miscarriage or abortion, you'll need to use additional contraception until you have taken the pill for seven days.